Federal Reports

OIG administers the Medicaid Fraud Control Unit (MFCU or Unit) grant awards, annually recertifies the Units, and oversees the Units' performance in accordance with the requirements of the grant. As part of this oversight, OIG conducts periodic reviews of all Units and prepares public reports based on these reviews. These reviews assess the Unit's adherence to the 12 MFCU performance standards and compliance with applicable Federal statutes and regulations.

The summarized results of our individual Medicare contractor reviews (issued between June 2014 and September 2015) revealed that for the period October 2003 through March 2011, Medicare contractors did not always refer Medicare cost reports that qualified for reconciliation, and the Centers for Medicare & Medicaid Services (CMS) did not always ensure that Medicare contractors reconciled the outlier payments associated with cost reports that had been referred. CMS relies on Medicare contractors to reconcile outlier payments, which compensate hospitals for high-cost cases. These reconciliations ensure that outlier payments reflect hospitals' actual costs.

The Massachusetts Department of Children and Families (State agency) generally complied with applicable Federal and State regulations for ensuring that children who were Title IV-E eligible and residing in foster care congregate care group homes received medical services during calendar year 2015 as required pursuant to Title IV-E of the Act.